Old age calls for caution. You have to be careful not to catch a cold, or miss a step. But now, it seems that senior citizens have to be cautious about a new old-age scourge — health insurance companies.
Take the case of Dara Engineer, a 57-year-old Mumbaiite. In trying to increase his Bajaj Allianz policy of Rs 1 lakh to Rs 3 lakh, Engineer was put through a stress test to check out his heart. The test report declared that Engineer should be excluded from cover for ischaemic heart disease. A thalium stress test — which doctors believe presents a more accurate picture — gave him a clean chit, but the insurance company continues to maintain a staunch silence on the matter.
Engineer’s case is certainly not an isolated one. Sheelu Srinivasan, co-founder of Dignity Foundation, an organisation for the elderly, believes that insurance companies are only interested in people in the 30-45 age group. “They let down seniors when they most need help — especially after crossing 65.” As a result, “many elders do not bother to get insured, taking loans for their treatment instead,” she says.
There are several problems that older citizens face. For one, most insurance agencies do not cover people above 70. And then, as some policy holders have found, the companies refuse to pay up when a person needs to be hospitalised, citing “pre-existing” health conditions as an excuse for non-payment.
Asha Idnani, a member of the Consumer Guidance Society of India in Mumbai, is all too familiar with the woes of seniors running from pillar to post to settle their claims. “Insurance companies are very prompt when it comes to collecting premiums, but don’t want to part with money,” she says. Most policy holders give up the fight, and few ever take legal recourse. “Consumer courts cannot offer any solution, given their huge case load,” says Idnani. “Many seniors would die in the process of getting justice,” she says.
Anand Patwardhan, a Mumbai-based consumer lawyer, is another one who thinks senior citizens are being harassed by health insurance companies. He holds that premiums are hiked up for older people when there is a recurring illness.
But insurance companies and their brokers insist that they are going by the rule-book. “In India , premiums are not revised very often, so when they are revised, the increase seems substantial,” says Sridhar Deshpande, head of Heath Insurance and Travel, Bajaj Allianz.
Joe Fernandes, a 76-year-old Mumbaiite, will have none of that. His health policy premium was suddenly hiked by Rs 3,000, and he was given only a week to pay up. And this hike came after he had already paid his regular premium in March this year, a fortnight before the due date. Patwardhan adds that when some insurance companies do not want to renew a senior citizen’s policy, there are occasions when they do not encash the policy holder’s cheque for payment of premium.
The companies, however, believe that there is nothing unfair in the tactics. “After all, it’s got to be a viable business,” argues Nitin Dossa, chairman and managing director, Dossa Insurance Services Ltd. Health insurance companies also operate on the fear of running into a loss, points out Maneck Dastur, direct broking, K.M. Dastur Reinsurance Brokers Pvt. Ltd.
The insurance companies blame the doctors and hospitals for high fees and costs, which force people to make use of their insurance policies. Bajaj Allianz’s Deshpande agrees that there is an issue there. He points out that advanced technology has led to an increase in surgeries which people would normally avoid, if they were not covered. Few, for instance, would go for a knee-replacement surgery if they were not insured.
But even when the surgeries are essential — in the case of a bypass, for instance — the insurers often come up with objections. “Why should they (senior citizens) go to top hospitals such as Breach Candy in Mumbai when the same surgery would cost three to four times less in Hyderabad'” asks an irate Dossa.
Insurers complain that people start going in for health insurance only in their middle age. “People should get insured at 25 and not at 55 when their chances of being hospitalised are so much higher,” says Dossa. “You pay a premium of Rs 5,000, and you are likely to run up a bill of Rs 7 lakh for a bypass surgery.”
What the insurance companies choose not to bring up is the fact that those crossing 55 pay more than twice as much as those below 35.
In Bajaj Allianz’s Silver Health cover plan for seniors, the hike in premium between the 61-65 and 66-70 age groups appears the highest — between Rs 3,000 and Rs 5,000. “But that’s because Silver Health is a policy where pre-existing diseases are covered after the first year,” says Deshpande.
But as Jehangir Gai, a consumer activist in Mumbai, warns, all that glitters is not gold. “One must read the fine print very carefully, to look for areas in the policy that are loaded heavily in favour of insurance companies,” he says. And those are golden words.